Posted tagged ‘fussy babies’

What really works to treat infant colic?

April 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Colic is not fun.

You’ve got your little wee baby home, and you’re exhausted. Just when you need some rest the most, Junior cries. And cries, and cries. And nothing seems to help for more than a few moments.

Colic has a medical definition, sometimes called “Wessel’s criteria”: inconsolable crying in an infant less than three months of age, for at least three hours a day, for at least three days a week, for three weeks or more. I doubt many practicing pediatricians or parents rely on all of those “threes.” We use a simpler definition: lots of crying in a baby who we’d hope would cry less.

Babies cry. And that’s the catch, here. They all cry. They don’t have much else they can say. And they’re overwhelmed by all of the changes they’re experiencing, and they haven’t yet learned how to transition from wakefulness to sleep. And some of them don’t like the feeling of rumbly gas in their tummies. And some are scared of their little baby farts. And some of them have parents who are exhausted and strung out and depressed. Honestly, I’m surprised more of them don’t cry all of the time.

But the crying, it can really wear parents down. So all sorts of things have been tried to help soothe crying babies. The latest hip idea (for colic, and almost everything else) is probiotic supplements. These are oral powders that are made of billions of healthy bacteria meant to populate a baby’s gut to help digestion. There’s a lot of research into the “gut biome” and the effect of gut bacteria on the health, specifically relating to digestion and abdominal pain and allergy. Why not toss these at colicky babies, see what helps?

Some studies have shown good promise. Just last month, a study of 589 infants in Italy compared babies given probiotics versus placebo, and found that the babies on a probiotic L reuteri supplement cried for fewer minutes each day (38 versus 71 minutes, on average.) This study looked essentially at the prevention of colic, by giving probiotic supplements to babies whether they had excessive crying or not.

However, the most recent study, a controlled trial of the same probiotic supplement given to colicky babies, showed no effect on any important outcome. The babies, whether given probiotics or not, cried about the same.

Still, there is some good news in common between the studies. The babies, when followed over time, all experienced decreased crying. In other words, colic improved in all groups, whether or not probiotics were given. Also, there we no side effects observed in the probiotic groups. They’re safe, even if they don’t work.

So what does and doesn’t work to help decrease infant crying?

Medicines, universally, don’t seem to work. This includes simethicone (widely available as “Mylicon”, an OTC “gas reliever.”) Studies of medications that reduce acid have also failed to show any effectiveness in improving infant fussiness or crying.

For nursing moms, dietary changes seem to help sometimes—specifically, eliminating dairy consumption. However, this is effective <50% of the time, and you have to weigh a trial of no-dairy-intake versus the effect this has on mom. She needs to be able to eat. Eliminating dairy is difficult (but not impossible)—but eliminating all of the foods possibly implicated in infant crying would be ridiculous. What’s mom supposed to eat, rocks and water? Besides, I don’t like pinning the blame for an upset baby on Mom.

For bottle-feeding families, using a hydrolyzed (hypoallergenic) infant formula has some mixed support from studies. It may be worth a try. What’s unlikely to really help, though, is the endless parade of changing formulas based on manufacturer claims that some are “soothing” or some help in other vague ways.

An insider pro tip I’m not supposed to tell you: As a pediatrician, I can suggest countless alternative formulas for you to try. There are enough alternatives that I can keep changing formulas once a week for at least a few months. By then, baby colic improves. So you’ll think I was smart to finally find the right formula, when in reality I was just changing formula once a week until your baby was going to get better anyway!

So what works best? First, colicky babies need a good, thorough evaluation to make sure that there isn’t a medical problem going on that needs to be addressed. Sometimes that takes more than one visit, and sometimes, if things aren’t going as expected, we have to revisit and re-assess.

But as long as there isn’t a medical issue contributing to the crying, the most important interventions are reassurance, education, and social support. Reassurance that colic does get better, education about safe soothing techniques and signs to look out for, and social support so exhausted parents can get a break once in a while. If parents want to try some safe interventions, that’s fine. But colic isn’t necessarily a medical problem that needs probiotics, diet changes, or medicine. Sometimes, babies just need to cry.